title: Epidemiology, diagnosis and treatment of fungal respiratory infections in the critically ill patient.
abstract: OBJECTIVE
  To elaborate practical recommendations based on scientific evidence, when available, or on expert opinions for the diagnosis, treatment and prevention of fungal respiratory infections in the critically ill patient, including solid organ transplant recipients.
  
  
  METHODS
  Twelve experts from two scientific societies (The Spanish Society for Chemotherapy and The Spanish Society of Intensive Care and Coronary Units) reviewed in a meeting held in March 2012 epidemiological issues and risk factors as basis for a document about prevention, diagnosis and treatment of respiratory fungal infections caused by Candida spp., Aspergillus spp or Zygomycetes.
  
  
  RESULTS
  Despite the frequent isolation of Candida spp. from respiratory tract samples, antifungal treatment is not recommended since pneumonia by this fungal species is exceptional in non-neutropenic patients. In the case of Aspergillus spp., approximately 50% isolates from the ICU represent colonization, and the remaining 50% cases are linked to invasive pulmonary aspergillosis (IPA), an infection of high mortality. Main risk factors for invasive disease in the ICU are previous treatment with steroids and chronic obstructive pulmonary disease (COPD). Collection of BAL sample is recommended for culture and galactomannan determination. Voriconazole and liposomal amphotericin B have the indication as primary therapy while caspofungin has the indication as salvage therapy. Although there is no solid data supporting scientific evidence, the group of experts recommends combination therapy in the critically ill patient with sepsis or severe respiratory failure. Zygomycetes cause respiratory infection mainly in neutropenic patients, and liposomal amphotericin B is the elective therapy.
  
  
  CONCLUSIONS
  Presence of fungi in respiratory samples from critically ill patients drives to different diagnostic and clinical management approaches. IPA is the most frequent infection and with high mortality.
authors.affiliation: Critical Care and Emergency Clinical Unit, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain. jgarnachom@gmail.com
authors.forename: José
authors.initials: J
authors.lastname: Garnacho-Montero
authors.forename: Pedro
authors.initials: P
authors.lastname: Olaechea
authors.forename: Francisco
authors.initials: F
authors.lastname: Alvarez-Lerma
authors.forename: Luis
authors.initials: L
authors.lastname: Alvarez-Rocha
authors.forename: José
authors.initials: J
authors.lastname: Blanquer
authors.forename: Beatriz
authors.initials: B
authors.lastname: Galván
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rodriguez
authors.forename: Rafael
authors.initials: R
authors.lastname: Zaragoza
authors.forename: José-María
authors.initials: JM
authors.lastname: Aguado
authors.forename: José
authors.initials: J
authors.lastname: Mensa
authors.forename: Amparo
authors.initials: A
authors.lastname: Solé
authors.forename: José
authors.initials: J
authors.lastname: Barberán
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015415:Biomarkers / Q000032:analysis; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D016638:Critical Illness; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D009090:Mucorales; D009091:Mucormycosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D016377:Organ Transplantation; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D013030:Spain / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents; D015415:Biomarkers